By Kasia Michalik
Four participants stood up October 11 at the 35th annual National Renal Administrator Association (NRAA) conference in Savannah, Ga., to discuss the hot topic in the renal community: home therapies, such as home hemodialysis (HHD) and peritoneal dialysis (PD). Their thoughts and the highlights are below.
Wayne Evancoe, from Hortense & Louis Rubin Dialysis Center, started in 1998 with PD and his clinic has been using the NxStage home hemodialysis machine since 2005. Currently, his clinic has 88 NxStage patients; two-thirds of those are nocturnal. Internet monitoring is used on about 80 percent of those patients that are spread across three states and across six nights a week.
According to the United States Renal Data System (USRDS), when you look at home programs, about 8.5 percent of the population is either on PD or HHD.
“One of the things that you have to look at is investing in your team,” Evancoe said in regards to developing a home program. “You don’t put your toe in the water, you have to take the full step with home dialysis and PD. People do make a difference, not one size fits all, you have to find that person that can dedicate themselves.”
Evancoe made a point that sometimes the non-compliant patient who is a problem in-center can be an amazing home dialysis patient.
He also pointed out something that everyone in this industry should know and that is that 93 percent of nephrologists, if they had end-stage renal disease (ESRD), would choose home therapy instead of in-center therapy.
“One of the things we look at now is wonderful clinical results. There are studies out there you can look up on different websites, we happen to use NxStage as a major platform,” Evancoe said. “Looking at those studies we look at not only the quality of life, but a lot of clinical results.”
In 2004, Satellite Healthcare looked at the company as a whole and found that it only had 9 percent of patients on home therapies. The chief medical officer thought that 9 percent was too small of a number. They looked at the why behind this small percentage and came up with barriers that stood in the way of this number from growing.
The model changed then and currently Satellite has been at about 28 percent of patients on home dialysis.